Kubiatowski Tomasz, Nicoś Marcin, Krawczyk Paweł
Department of Medical Oncology, Center of Oncology of the Lublin Region, Lublin, Poland.
Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, Lublin, Poland.
Front Oncol. 2020 Nov 19;10:568081. doi: 10.3389/fonc.2020.568081. eCollection 2020.
The use of immune checkpoint inhibitors (ICIs) delivered great and new possibilities in modern treatment of many types of cancers. This therapy based on blockade of such molecules as CTLA-4 (cytotoxic T lymphocyte-associated antigen), PD-1 (programmed cell death receptor type 1), or PD-1 ligand (PD-L1) brings a new hope for patients with non-small cell lung cancer (NSCLC), melanoma, or head and neck squamous carcinoma. Efficacy of immunotherapy was proven in many clinical trials. Unfortunately, ICIs treatment was not addressed to the patients with preexisting allogeneic transplants or autoimmune diseases mainly due to high risk of transplant rejection, exacerbation of autoimmune diseases, and risk of serious toxicity. However, it is possible to receive anti-tumor response to ICIs treatment avoiding graft rejection by adjusting the immunosuppression. Obviously, it depends on the type of transplants: the use of immunotherapy is usually possible in kidney or corneal recipients, but it could be difficult in patients with liver and heart transplant. Therefore, the development of biomarkers for tumor response and transplant rejection in ICIs treated patients is essential. Data coming from published literature support the possibilities of using ICIs in patients with preexisting autoimmune diseases who undergoing proper management of side effects of immunotherapy or when the potential benefits of such treatment outweigh the potential risks. This depends on the type of autoimmune disease and may be difficult or not feasible in patients with systemic lupus erythematosus or systemic sclerosis. Therefore, it may be appropriate to include cancer patients with preexisting autoimmune disease or with allogeneic transplants in clinical trials using immunotherapy when no other effective cancer treatment options exist.
免疫检查点抑制剂（ICI）的使用为多种癌症的现代治疗带来了巨大的新可能性。这种基于阻断细胞毒性T淋巴细胞相关抗原（CTLA-4）、程序性细胞死亡受体1型（PD-1）或PD-1配体（PD-L1）等分子的疗法，为非小细胞肺癌（NSCLC）、黑色素瘤或头颈部鳞状细胞癌患者带来了新希望。免疫疗法的疗效在许多临床试验中得到了证实。不幸的是，ICI治疗主要由于移植排斥风险高、自身免疫性疾病加重以及严重毒性风险，不适用于已有同种异体移植或自身免疫性疾病的患者。然而，通过调整免疫抑制，可以在避免移植排斥的情况下获得对ICI治疗的抗肿瘤反应。显然，这取决于移植的类型：免疫疗法通常适用于肾或角膜移植受者，但对于肝和心脏移植患者可能会有困难。因此，开发用于ICI治疗患者的肿瘤反应和移植排斥生物标志物至关重要。来自已发表文献的数据支持在对免疫疗法副作用进行适当管理或这种治疗的潜在益处超过潜在风险时，将ICI用于已有自身免疫性疾病的患者。这取决于自身免疫性疾病的类型，对于系统性红斑狼疮或系统性硬化症患者可能困难或不可行。因此，当没有其他有效的癌症治疗选择时，在使用免疫疗法的临床试验中纳入已有自身免疫性疾病或同种异体移植的癌症患者可能是合适的。
